Promising News in Treating Multiple Myeloma

Advances in treating multiple myeloma have transformed the field over the past decade, giving clinicians more effective therapy options for newly diagnosed patients who are candidates for stem cell transplant and those who are not.

But the best may be yet to come, with 2 promising monoclonal antibodies on the horizon, according to Kenneth C. Anderson, MD, of the Dana-Farber Cancer Institute. Dr Anderson discussed treatment advances Saturday at the National Comprehensive Cancer Network’s (NCCN) 19th Annual Conference: Advancing the Standard of Cancer Care, held in Hollywood, Florida.

Dr Anderson said the 9 new approvals for multiple myeloma from the US Food and Drug Administration (FDA) have prolonged median survival for patients 2 to 3 years, with most patients now living 5 to 7 years with the disease. “In spite of all this, we still need novel agents,” he said, before sharing his optimism about therapies in the pipeline.

The addition of bortezomib has rewritten NCCN guidelines in recent years, and the 2014 version Anderson shared features the proteasome inhibitor in various combinations with immunomodulatory drugs in 5 of the 6 preferred regimens for patients who are transplant candidates.

Positive results on bortezomib-based regimens continue to come in; Dr Anderson reviewed data presented at the American Society of Hematology (ASH) meeting in New Orleans in December 2013, which he said show that the treatment consistently improves progression-free survival by an average of 9 months and overall survival, with a median of 84 months reached.¹

For patients ineligible for transplant, a new standard of care has emerged, Dr Anderson said. Based on the results of the FIRST trial presented at ASH in December, lenalidomide and low-dose dexamethasone (Len-dex) has been moved into the NCCN guidelines. At a massive, standing-room only plenary session, Thierry Facon, MD, presented results showing a 28% better survival rate than patients taking the previous standard of melphalan, prednisone, and thalidomide (MPT).²

On Saturday, Dr Anderson emphasized the real-world practicality that Facon noted at ASH¹: The FIRST trial (Frontline Investigation Of Lenalidomide + Dexamethasone Versus Standard Thalidomide) involved a large group of relatively older patients, much closer to the group that will be developing multiple myeloma as the population ages.

For all the good news, however, Dr Andereson said multiple myeloma remains incurable. New approaches are needed to treat and ultimately prevent relapse, he said. “I want to get you excited about the future,” Dr Anderson said. “We think we’re finally going to get a monoclonal antibody or two.”

The bright spots are: elotuzumab, which is currently in phase III trials but has shown very promising results in combination with Len-dex; and daratumumab, which in June 2013 became the first single-agent monoclonal antibody to receive FDA breakthrough status for relapsed and refractory multiple myeloma.³

Dr Anderson’s final conclusion may be the most exciting of all: It’s not just the newly diagnosed patients who are benefitting from the advances, but patients who have relapsed as well. Incorporation of novel therapies at all stages of disease is further improving patient outcomes, he said.

References

1. Sonneveld P, Scheid C, van der Holt B et al. Bortezomib induction and maintenance treatment improves survival in patients with newly diagnosed multiple myeloma: extended follow-up of the HOVON-65/GMMG-HD4 trial. [ASH Abstract 404]. Blood. 2013;122(21).
2. Caffrey MK. When less is more: results herald “paradigm shift” in treating newly diagnosed multiple myeloma patients. Am J Manag Care. 2014;20(SP2):SP51.
3. McCall B. Daratumumab response high and durable in multiple myeloma. Medscape. http://www.medscape.com/viewarticle/806458. Published June 18, 2013. Accessed March 16, 2014.